Examples

• Matthew Donnelly, a physicist who developed cancer after working with x-rays for 30 years. His cancer cost him his eyes, jaw, lips, nose, hand, and part of the other. Estimated to have one year to live, when doctors refused his request that he be allowed to die, he asked his brothers to do it. After a few weeks, his youngest brother shot and killed him.
• Edward E, an 89 year old senile, hospitalized patient. He had suffered three heart attacks, had bad kidneys, and would not be able to leave the hopsital. The chief of medicine instructed that the next time he had a heart attack that he should not receive treatment. The next time he had a heart attack, he died.

Definitions, One More Time

• Euthanasia is Greek for “Good Death” and is the practice of killing a person or animal a painless or minimally painful way, for merciful reasons, usually to end their suffering.
• In the strictest sense, euthanasia involves actively causing death. More recently, it has come to be mean assisting others to commit suicide.
• From the time of the popularization of Judaism and Christianity, there has been a profound split between East and West on the issue of euthanasia:
  1. Passive Euthanasia refers to allowing death of a patient by not providing life support or medication. Often, Living Wills and Do Not Resuscitate orders are involved.
  2. Active Euthanasia refers to the process of inducing death in a patient, often through the use of terminal sedation.

The Law Today

• The Netherlands has the most permissive society in the world with regard to euthansia. The law there allows euthanasia when all of the following have been met:
  • the patient has asked repeatedly
  • the patient's suffering is unbearable with no prospect of improvement
  • the doctor has prior to the act consulted a colleague.
  • the patient has to be at least 12 years old; patients between 12 and 16 years of age require consent of their parents
• In 2003, there were 1626 cases of euthanasia where a physician was involved
• Oregon is the only US state that has legalized physician assisted suicide.
  • The Oregon law only allows the doctor to prescribe a treatment.
  • Since 1998, 171 people in Oregon have used the law.
    • The law requires that the patient
      • must be terminally ill
      • must have 6 months or less to live
      • must make two oral requests for assistance in dying
      • must make one written request for assistance
      • must convince two physicians that she/he is sincere, is not acting on a whim, and that the decision is voluntary
      • must not have been influenced by depression
      • must be informed of "the feasible alternatives, including, but not limited to, comfort care, hospice care and pain control."
      • must wait for 15 days

Three Philosophical Arguments for Euthanasia

Utilitarian Perspective

• The central aim of utilitarian thinking is that one ought to make decisions that maximize pleasure and minimize pain.
• John Stuart Mill wrote that “The individual is sovereign over his mind and body”
• If one takes the perspective of utilitarian thinking and applies it to the individual, only that person can make the choice with complete knowledge.

Situational Ethics

• Joseph Flecher argues that we must rely on Situationalism to come up with the best answer. He argues that situationalism is the middle ground between prescriptive Legalismand Antinomianism (where a person makes a decision sponateneously).
• His theory of Situationalism argues that Each individual has an understanding of the “general rules” and guiding principles of his/her culture and theology. S/he uses this information to evaluate the situation and then adopts or rejects the “rule” so that the Love (or highest good) can be served in the situation. The only absolute, according to Fletcher, is love.
• For Fletcher, it cannot be permissible to allow a person to suffer because of a prescriptive set of moral laws. Instead, one's decision must be guided by charity and mercy.

Mercy

• The highest aspiration of medicine must be helping patients, not prolonging treatment.
• Advocates of this position often cite the work of the journalist Stewart Alsop, who died of cancer in 1975. Before he died, he wrote about his experiences with another terminal patient, named Jack: "The third night that I roomed with Jack in our tiny double room, in the solid-tumor ward of the cancer clinic of the National Institute of Health in Maryland, a terrible thought occurred to me. Jack had a melanoma in his belly, a malignant solid tumor that the doctors guessed was the size of a softball. The doctors planned to remove the tumor, but they knew Jack would soon die. The cancer had now spread out of control. Jack, about 28, was in constant pain, and his doctor had prescribed an intravenous shot, a pain killer, and this would control the pain for perhaps two hours or a bit more. Then he would begin to moan, or whimper, very low, as though he didn't want to wake me. Then he would begin to howl, like a dog. When this happened, he would ring for a nurse, and ask for the painkiller. The third night of his routine, a terrible thought occurred to me. 'If Jack were a dog, I thought, what would be done to him?' The answer was obvious: the pound, and the chloroform. No human being with a spark of pity could let a living thing suffer so, to no good end." (James Rachel's The Morality of Euthanasia)

Four Philosophical Arguments Against Euthanasia

Medical Ethics

• The Hippocratic Oath forbids doctors from euthanasia. “I will give no deadly medicine to any one if asked, nor suggest any such counsel.”
• It is argued that if doctors become involved in the termination of life, it will dimish the bond of trust between patients and their doctors, harming medical treatment.
• Currently, the AMA forbids active euthanasia, but permits passive euthanasia
• Almost all philosophical perspectives now (including the Catholic Church, traditionally opposed to euthansia, permit passive euthanasia

Respect for Human Life

• Others argue that it is difficult to make moral decisions about the quality of life, or dangerous to suggest that life does not have value. These advocates fear that life would lose its unique value in society.
• From a statement by the US Catholic Bishops: “To destroy the boundary between healing and killing would mark a radical departure from longstanding legal and medical traditions of our country, posing a threat of unforeseeable magnitude to vulnerable members of our society. Those who represent the interests of elderly persons with disabilities, and persons with AIDS or other terminal illnesses, are justifiably alarmed when some hasten to confer on them the "freedom" to be killed.”
• Some philosophers, and disabilities advocates also argue that it is dangerous and morally wrong to view the disabled as somehow less than fully human.

Negative Consequences of Utilitarian Thinking/Slippery Slope

• Allowing utilitarian thinking to influence life and death decisions can be dangerous. Would utilitarian calculations allow killing the indigent, the very elderly, the very young?
• Some philosophers have argued that these groupd could be easily vicitimized by hospitals, families and governments with financial motivation to end their lives.
• Some utilitarian thinkers have increased these fears, notably Peter Singer, who wrote, “"Killing a defective infant is not morally equivalent to killing a person. Sometimes it is not wrong at all.”
  • In 1989, the U.S. Civil Rights Commission issued a 153-page report entitled "Medical Discrimination Against Children with Disabilities." Among the events considered by the Commission was an experiment conducted from 1977 to 1982 at the Children's Hospital of Oklahoma. Doctors there developed a "quality of life" formula for babies with spina bifida, taking into account the socioeconomic status of the baby's family to determine what to advise families about a simple but life-and-death procedure. Better-off families were provided a realistic and optimistic picture of their child's potential. Poor families were provided a pessimistic picture. All of the families who were given an optimistic picture asked for medical care for their children. Conversely, four out of five poor families agreed not to treat their children, and twenty-four babies died. The U.S. Civil Rights Commission concluded:
  • To accept a projected negative quality of life . . . based on the difficulties society will cause . . . , rather than tackling the difficulties themselves, is unacceptable. The Commission rejects the view that an acceptable answer to discrimination and prejudice is to assure the "right to die" to those against whom the discrimination and prejudice exists.1
• The doctors conducting the study developed a "formula" which they published as part of their write-up in "Pediatrics", the most famous and influential medical journal devoted to the care of children.
• This is their "formula": Quality of Life is Natural Endowment by the contribution of the Home plus the contribution of Society. In a more mathematical style it reads: QL equals NE * (H + S). The doctors measured the "H" - the contribution of the home - primarily in financial terms: family income, family debt, employment and employability of the parents, etc. The parents' "intellectual resources," defined in terms of their educational level, were also included in the calculation of "H," which had the effect of crowding the pessimistic outcome group with parents less likely to challenge the doctors' "facts".
• This argument also maintains that once euthanasia is permitted, we will be on the ol' slippery slope. Many who argue against euthanasia fear that once it becomes legally permissiable, euthansia will spread beyond narrowly defined allowances. Soon, any number of patients could be a risk.
• Jonathan Pincus, M.D., from Yale, writes: "I have yet to hear of a set of guidelines for euthanasia which would not lead to terrible abuses even in the opinion of those physicians who are sometimes willing to practice it. Inevitably, this form of ‘therapy’ would spread to situations in which at present it would be unthinkable.”
• Such arguments often rely on the example of the Nazis, who were said to begin with the seriously disabled.